Wednesday, December 26, 2012

Last week Phil Dolan interviewed Carl Natale on the subject of
using social media to share and/or acquire information about ICD-10. You can
see the 2-part interview here: Part 1 and Part 2

As someone who
works in, studies and shares ICD-10 information on a regular basis using social media, I thought I’d
share some information as to how I leverage social media to both acquire and
share useful ICD-10 education, planning, assessment, remediation and testing
information. In this 1st part of my 2 part post, I’ll identify who I
believe are the social media leaders among the various categories Carl
outlined in his interview. In the 2nd part I’ll share techniques and tips for
locating and sharing ICD-10 information via social media channels.

Disclaimer:

I don’t represent anyone other than myself; I am not a
Vendor, Government Organization, Provider, Association Community Manager or
Payer – although I will say my knowledge and perspective are largely focused
from the perspective of a payer and risk-bearing provider. Also, the ICD-10 social media sources listed here are not intended to be an exhaustive list - just a sampling of what ai think are good sources..

What Entities Share ICD-10 Information via Social Media?

Most players in
the ICD-10 space are sharing information using social media and using multiple
different media and channels to do so.Moreover, as Carl notes, each player category seems to have a common social
media profile and editorial agenda. Some of these entities offer a wide range of media formats including tweets, newsletters, email updates, pod casts, webinars, conference calls and even a talk radio show.

Hate to say it but I don’t have any good recommendations in this
category.It’s dis-appointing.I guess perhaps that’s why I do what I
do.See @ShimCode in Individuals &
Untethered Consultants below.

Providers – Institutional, Professional &
Ancillary/Other

Just like Payers above, I don’t have any good recommendations in
this category.I’d like to stretch and
add the American Medical Association (@AmerMedicalAssn) and the Medical Group
Management Association (@MGMA) into this category but, in my opinion, neither
organization provides any good ICD-10 information; at least any information you don’t
have to pay for.

I hope this information is useful.Check out my 2nd part next Thursday where I’ll share techniques and tips for both locating
and sharing ICD-10 information across various social media channels.Remember, it’s always better to give than
receive!

Friday, December 21, 2012

Here are 10 good education and references on the topic of
ICD-10.I base this on the value each
provided to me as a healthcare service manager, systems analyst, project
manager and individual who supports others working on ICD-10-related projects.

Wednesday, December 19, 2012

PPACA
envisions that in October of next year, health insurance exchanges (HIX) will
be the primary method for adding tens of millions of uninsured Americans into
the healthcare system.My prediction is that
undefined/complex requirements, enormous technical and operational challenges
and a myriad of other distractions will prevent the federal government – and
many states – from delivering the promise of HIX’s until later in 2014 – if
even then.

Undefined, Complex Requirements

With
less than a year until deployment, many key decisions and rules as to how
health plans will participate have not been fully defined.

Regulatory
variations across states will unduly complicate how health plans serving these
states will produce and consume enrolments originated from these HIX’s.

Technical and Operational
Challenges

There
are major operational and technology aspects associated with implementing and
operating a health insurance exchange. It’s not reasonable these aspects will
be understood, delivered and tested in less than one year!

Most HIX
users are expected to be low-income individuals. The eligibility and enrolment
processes and systems needed to enrol, track and process changes for this
historically mobile and volatile user base are very complex; ask anyone who has
been involved with Medicaid eligibility and enrolments.Add in the need to determine premium tax
credits, allocations and other subsidies and you have one very complex system
to design, build and test – again in less than a year.

Coordinating
billing and payment flows and all the retroactive additions, cancellations and reconciliations
between multiple parties – all impacted by overlapping state laws and
department of insurance regulations.

Distractions

Right
now, most states have decided not to set up their own exchange but rather rely
on The Feds to create and run the HIX for them. This forces The Feds to take on
a much larger role than they originally anticipated. There’s a dearth of
healthcare and IT resources. Will the feds be able to acquire the resources to
deliver on their gamble?

Like
all states, private payers and providers, The Feds (CMS/HHS/IRS/Etc.) are also
greatly impacted by the Affordable Care Act, HITECH and new standards
regulations. Just about every other program initiated by The Feds – HIPAA 5010,
ICD-10, Meaningful Use, etc. – have seen delays and/or scaled back
expectations. What makes anyone think that health insurance exchanges will be
any different?

So…my
prediction for 2013 is that the deployment of federal health insurance
exchanges in October 2013 will not happen – at least as originally envisioned.

Friday, December 7, 2012

As payers and providers progress through their ICD-10
project, some common areas of risk will become obvious.Whether you’re a payer or a provider, the
following are some common areas of risk that should be considered along with
some ideas for addressing their mitigation.

Utilize a coding specialist to review benefit and contract
configurations. Develop tools and methods to assist with configuration
changes.

Trading partner Readiness

Surveys. Establish a dedicated workgroup

Inter-dependencies with other systems and procedures

Hold regular meetings. Communication. Ideation of workarounds.

Missed areas

Survey end users. Require formal signoffs from business area leads.

Testing

Establish a dedicated team. Employ the use of stubs to enable early
end-to-end testing.

Payments

Payment Modeling. Encourage provider-payer collaboration

Vendor readiness

Surveys. Repeated follow-up. Collaborate with other users of the
vendor’s product(s) Lobby for commonly needed information!

Resource availability

Project plans. Measure hours. Hire resources that can be converted to
FTE after project.Leverage internal
SME’s.

Impacts from other projects

Attend project meetings.Read status
reports and meeting minutes.

Educate PM’s and SME’s of other projects as to the various forms of
ICD-10 impact.If possible, avoid
enhancements and changes involving ICD, DRG and diagnosis-related
information.

While some of the above risks may have greater or lesser
impact depending on whether you’re a provider or a payer, where you are in the
ICD-10 implementation and the size and nature of your organization, your
project should have a risk assessment and mitigation plan that includesthese and other potential risks.

Thursday, November 29, 2012

If anyone thinks they will be able to perform comprehensive
testing of all ICD-10 coding and processing scenarios, they’re on a Fool’s Errand. There are just too many potential claim coding and payment processing
variations between providers and payers due to how selected ICD-10 codes can be
applied to benefit plan and medical management policies.Add in the unlikely readiness and unpredictability
of multiple vendor systems and intermediary processing through claim pathways
and you’re on your way to going out of business.

Here are some information, ideas, opinions and random thoughts about using medical scenarios to
focus your ICD-10 testing.

What’s Your Scenario?
Do You Come Here Often?

Spend some time identifying your most common medical scenarios
by determining high volume, high-risk ICD-9 codes. Then look at how the
following may alter each of these medical scenarios:

1. Type of encounter (initial or subsequent or sequelae?)

2. Applied specificity (did the patient lose
consciousness?)

3. Acute versus chronic

4. Relief or non-relief (intractable versus
non-intractable?)

5. External cause (was it caused by an accident? – i.e.
Other Party Liability?)

6. Activity (what was the patient doing when ‘injured?’)

7. Location (where was the patient when injured?)

Define standard test data sets for each of these medical scenario
variations. Determine which ICD-10 code(s) YOU THINK are associated with each of them.
Then get your payer/partner to what THEY THINK and have them explain how they’d
process your scenario AND their scenario.

If your existing medical records don’t have enough detail to
create these medical scenarios, then make up the data. And start planning how you’re
going to improve your medical records!

Healthcare is Local

Consider how your locale, region and state may dictate the
composition of your medical scenarios. Certain medical scenarios may apply only
to a specific region, locale or state.

“Edge” providers and payers servicing two or more states may have
extra work to do.

Focus, Focus, Focus –
Choose Wisely

You MUST manage the scope of your medical scenarios –or you’ll
end up defining many poorly defined scenarios instead of fewer, more important scenarios
that thoroughly reflect your business.

Avoid wasting time on customized variations and edits
associated with certain trading partners – unless they represent a major
portion of your business

Testing with external partners requires multiple companies
to be “ready” and have resources committed to test at the same time.

If ever there was a time to focus on the Pareto Principle it’s
with ICD-10 testing.

Either You’re With Us
or Against Us

Payers and providers will be impacted by, but may have
limited control over, vendor readiness, including their test schedules and
ICD-10 remediation logic.

Make a concerted effort to reach out to your primary
business partners and document your interactions with them.Sometimes you’ll have no control and be
ignored. Don’t sit back.Approach and
confront, if necessary

<Lawyering On> Having clear, contemporaneous records
of your interactions with business partners is ALWAYS a good thing. <Lawyering
Off>

The Scenarios Better Work
Good in the Morning

The ICD-10 morning is coming October 1, 2014. No one wants
to wake up mourning over a nightmare.So
think about some of what I’ve presented above and make a pledge to make smart choices
as to which ICD-10 Medical Scenarios you choose at closing time approaches.If you want to learn more about ICD-10 and Healthcare IT in general, be sure to Follow me on Twitter.

Thursday, November 8, 2012

On October 1, 2014 your systems and procedures will have a
choice to make: Claims with dates of service (professional) or discharge dates
(institutional) PRIOR TO 10/1/14 must be processed based on ICD-9 codes. Claims
with dates of service (professional) or discharge dates (institutional) AFTER
10/1/14 must be processed based on ICD-10 codes. This capability is generally referred to in the industry as “dual use” capabilities.

But Will Dual Use Capabilities Be Sufficient?

Based on what I’ve read and understand, most payers will
establish a policy of rejecting claims that contain the wrong ICD code relative
to the currently defined 10/1/14 compliance date; either the claim is processed
or rejected. But what happens if CMS waffles again and allows a “non-enforcement
period” subsequent to 10/1/14?Perhaps
allowing providers to submit claims containing ICD-9 or ICD-10 codes without
regard to date of service (professional) or discharge dates (institutional) - just like
CMS did earlier this year with HIPAA 5010 transactions.

Some Questions for Now - Rather Than Later

Will your systems and processes be flexible enough to
accommodate the non-enforcement period? What design approaches, planning
and testing considerations can you make now to accommodate potential relaxation of the ICD-10 compliance date? If you are dependent on vendor solutions, are those solutions capable of both dual use and flexible use?